Utilization Review Clinician - Appeals
Remote - USRemote (US)
Posted 2 days ago · via Workday
About this role
* This role will require the successful candidate to work the shift of either: Monday to Friday, Noon to 9pm Eastern, OR Wednesday through Saturday, 10am to 9pm Eastern. The Appeal Review Clinician is responsible for handling appeals cases and relevant information. The scope of this job may include handling health plan and Medicare Quality Improvement Organization (QIO) appeals, including expedited appeals, reconsiderations and medical necessity reviews. This role ensures compliance with CMS regulations, organizational policies, and established clinical guidelines.…
What we'd score you on
reqspace match rubricFive dimensions, recruiter-grade. Upload your resume and we'll generate a written explanation of where you fit and where the gaps are.
1
Skills match
For this role: monday
2
Level fit
We check your title trajectory against the seniority signal of the role.
3
Domain experience
Your work in the role's domain matters more than your years total. We weight recent and direct experience.
4
Recency
A skill you used last quarter weighs more than one from five years ago. We grade on recency, not lifetime.
5
Location fit
This role is remote-eligible — we factor in your stated location and time-zone overlap.
Score yourself on this role.
Free · no card · written explanation included
Skills in this role
Pulled from the job description. These are the keywords we'll weight when scoring your fit.
monday